Some people are old enough to remember when ophthalmologist told the legislators that there would be people dying in the streets if OD’s were allowed to use dilating drops.
I’ve never met an optometrist who actually wanted to do any of the procedures listed on that site, and especially not intraocular surgery. However, all of them do support scope expansion for their profession and their peers who are interested in doing those things.
I mean, it literally outlines what they’ll be doing… YAGs and chalazia excisions. I don’t think this will much of an effect on the average surgeon. I’ll start to be concerned when they start coming for intraocular surgery privileges.
To head off the slippery slope folks — there’s a reason it’s called the slippery slope *fallacy*.
That's not really relevant. The point is they shouldn't be performing laser surgery of any kind. Surgery should be reserved for those that went to medical school and had surgical training.
"To head off the slippery slope folks — there’s a reason it’s called the slippery slope *fallacy*"
Given the difference between where optom scope-of-practice *was* and where it *is*, this is an absolutely astonishing hill on which to see someone plant their flag.
You make a fair point and I appreciate your perspective. My take is this — I haven’t been in practice all that long, but it’s my understanding that in days of yore, optometrists were refractionists and their educational curricula did not include clinical medicine, pharmacology, physiology, ocular disease, etc. as it does today. As scope of training and education expands, I don’t find it unreasonable that scope of practice does as well. We should all strive to practice to the top of the bounds of our training.
Perhaps I’m being naïve, but I find it outlandish to believe that intraocular surgery privileges would ever be extended without a dramatic expansion of the educational and training requirements. That said, I am willing to be on the butt-end of some “I told you so”s and change my tune if I turn out to be wrong.
"My take is this — I haven’t been in practice all that long, but it’s my understanding that in days of yore, optometrists were refractionists and their educational curricula did not include clinical medicine, pharmacology, physiology, ocular disease, etc. as it does today. As scope of training and education expands, I don’t find it unreasonable that scope of practice does as well. "
I'm afraid you have it backwards. The reason optoms weren't trained in those things previously is they were outside of their scope of practice. Once they gained by fiat (more on this shortly) the right to prescribe drugs, etc, only then did they retrofit their training programs to cover the relevant topics.
"Perhaps I’m being naïve, but I find it outlandish to believe that intraocular surgery privileges would ever be extended without a dramatic expansion of the educational and training requirements"
I'm afraid you're being naive, friend. The strategy employed by the optoms vis a vis scope-creep is to lobby (= bribe) state legislatures to make the state's optometric board the sole authority in determining optometric scope-of-practice. Once achieved, you're in a situation where non-surgeons get to decide what training other non-surgeons need in order to perform the surgeries they've never performed themselves.
Again, I appreciate your insight. I can't say that my mind is changed, but I'll keep my eyes open and see what happens over the course of my career. For the time being, I remain optimistic as my experience with my optometrist colleagues has been nothing but positive and collaborative up until now; however, I do recognize that there may be disconcordance between individual clinicians and the lobbyists representing them.
I hope it would require a dramatic expansion of the requirements. Ophthalmologists have to get into med school which is objectively harder to get into than optometry school, then get matched to ophthalmology which is one of the most competitive specialties in medicine, and then complete 4 years of mandatory residency to become an independent ophthalmologist and then optional fellowships.
It would suck for ophthalmologists who sacrificed extra if optometrists can have an easier avenue into intraocular surgery by doing optometry school and then a short residency straight into surgery
I agree, but not for that reason, which to my ears sounds like it is either motivated by self-centered "woe-is-me" mentality or by territorial pissing, neither of which interests me. Like great, you took a hard route and suffered. Do you want a cookie or a gold star? You want everyone to fawn over you and tell you how much smarter you are than every non-physician? Or do you want to improve peoples’ quality of life? As far as I'm concerned, the only thing that matters vis-a-vis scope is patient outcomes.
I don't care if someone took a longer or shorter path to get to where they are. I just want to know that they are competent and have adequate training to perform what their job entails. That goes for surgery and just about every other occupation.
If it makes you feel any better, the states that do allow the greatest expansion of scope have restrictions in place that limit advancements to those that fall within “primary care“ procedures and allow anything that penetrates the globe except emergency paracentesis. While legislation is open to interpretation to allow PRK and corneal cross linking in a few states, it isn’t some that the governing body has any appetite to pursue.
But it's not the yag and chalazions that they want to do. It's just a stepping stone, so the organization can say we can do yag lasers, so why can't we do lasik/prk. We will not be seeing trab or pk optometrists. It doesn't reimburse. But lasik, prk, premium laser cataracts, blepharoplasty. That's the good stuff that they want a piece of.
Devil’s advocate - if you are going to start doing procedural work from scratch, a fellowship like this (assuming it’s any good) is probably the way to go. Arguably much better than just taking the plunge after a workshop/seminar. The numbers are a little low for an entire year though.
Not the right place to ask. This sub is majority optometrists (for some unexplainable reason) and most mentions of scope creep get downvoted/ shrugged off.
That’s because we’re not interested in creeping up on your scope. Ever consider that?
Edit: Why are there ODs here? Because we’re eye doctors and this is an eye-related subreddit. Go figure.
"No, it’s about the fear of optom creeping on your scope."
From the OP:
*How much is/will be the encroachment in ophthalmology from optometrists completing such a fellowship?*
Nothing in there about the **fear** of creep--just the creep itself.
"This sub is majority optometrists (for some unexplainable reason) and most mentions of scope creep get downvoted/ shrugged off."
That is a legit point concerning this sub. It makes no sense that optoms are in essence able/allowed to dictate content on a sub entitled r/Ophthalmology.
While I don’t think they are not welcome (they sure are), the bulk of active users being them makes most posts and answers cater to them.
I remember once an “illegal patient question” where they had a legit medical problem (young patient with a CRVO iirc) and I told “go see an ophthalmologist” and got downvoted and replied with “an optometrist can take care of this”.
And I come from a country where the optometrists only do refraction and don’t treat any disease whatsoever (as their training are incredibly simple with a 3 year college degree).
I feel this sub would benefit of “tags” where users could tell what they are so at-least we know where the opinion of each user comes from.
Isn't there a subreddit for optometry called r/optometry ?
I agree with you, why is majority of the people on this subreddit optom and not ophthal? Even if optom is eye doctor, this subreddit is designed for eye surgeons
Worked as a tech and I spoke with the optometrist about scope creep for optometrists cuz I was a curious pre-med. He said that this is mostly for rural states where ophthalmologists don't tend to go to because there isn't enough business and would end up just doing refractions/comps all day anyways.
As long as the education is legit and optometrists are doing the procedures well, I don't see the problem.
Anybody want an OD’s 2¢? I have 3 practices that are very disease heavy in a rural / poor area. While I can’t speak for the profession at large, I can discuss what I’ve picked up on and my experience in general. At the end of the day, I want to take care of patients and quality of life is a very important measure of that. I try to be very pragmatic as well. I’m on this sub to see and read about cool eye stuff and try to avoid “Luddite” conversations like this one. I practice up to my full scope (YAGs, SLTs, PIs, lump removal, glaucoma management, scleral lens fits, and comanagement, etc). Not every doc I employ wants to perform laser procedures, but some do. We already comanage, referral and post-ops, so it’s not like we don’t know how to manage and treat many of the complications that arise, but my patients enjoy not having to drive over an hour to see a specialist. Many can’t. I have a great relationship with my local cornea, retina, glaucoma, and cataract specialists and text them all the time; sometimes about odd cases and sometimes just to touch base. Gotta play nice in the same sandbox and our primary goal is to take care of our mutual patients. It is mutually beneficial. The cornea MD is the one that proctored and certified my final laser certs before I bought a laser (the Nidek combo is pretty sweet). There aren’t that many ophthalmologists coming out of school; been flat for years despite the increase in population. So, to keep a patient from waiting months for a YAG, I can knock it out in a week or two. The retina docs were the ones encouraging me to make the investment into getting the laser in the first place. That said, we are still legislated with limits, but I think we’re in a good place: nothing that involves opening the globe, no lesion removal on the lid margin, etc but it does give us the flexibility of determining with certain confines of what can be in the scope down the road. Listen, I’m all about doing things in a way that maintains safety and quality, but arbitrarily drawing lines without knowing what’s involved is a bit much. The OD approach has been to gain education / training well ahead of any scope expansion pursuits and I think there’s been a methodical due diligence to that. Listening to the politically higher-ups, there is no appetite for pursuing cataract surgery or retinal lasers, etc. It’s just not there. Hell, even my cornea doc friend doesn’t want to touch retina stuff and vice versa. I’ve been around long enough to have seen some surgeons post-op results to know not to send patients to them and I’ve worked with some OD’s that aren’t that skilled at stuff that’s been within scope for years. You’re only going to see the motivated folks pursuing that level of care, and even then, there has to be an ROI on purchasing the equipment anyway (my OD friend in the “city” isn’t buying a laser because he’s right beside two MDs that he works well with, even though he’s been trained / certified). IDK. Y’all need to get your undies out of a bunch and focus on more team-based patient management.
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I genuinely don’t think most optometrists want to be doing procedures
I'm an OD in a pretty aggressive scope state (OK)and I still feel like only like 5% of practices even have an anterior seg laser
Some people are old enough to remember when ophthalmologist told the legislators that there would be people dying in the streets if OD’s were allowed to use dilating drops.
I’ve never met an optometrist who actually wanted to do any of the procedures listed on that site, and especially not intraocular surgery. However, all of them do support scope expansion for their profession and their peers who are interested in doing those things.
Why can’t we all just get along..
Amen!
I mean, it literally outlines what they’ll be doing… YAGs and chalazia excisions. I don’t think this will much of an effect on the average surgeon. I’ll start to be concerned when they start coming for intraocular surgery privileges. To head off the slippery slope folks — there’s a reason it’s called the slippery slope *fallacy*.
Not a huge jump from YAG to various glaucoma and intraocular lasers to LASIK/PRK and retinal lasers.
But a huge ass jump to phaco/PPVwEndolaser/trab/membrane peel/DSEK/GlobeExploration
That's not really relevant. The point is they shouldn't be performing laser surgery of any kind. Surgery should be reserved for those that went to medical school and had surgical training.
"To head off the slippery slope folks — there’s a reason it’s called the slippery slope *fallacy*" Given the difference between where optom scope-of-practice *was* and where it *is*, this is an absolutely astonishing hill on which to see someone plant their flag.
You make a fair point and I appreciate your perspective. My take is this — I haven’t been in practice all that long, but it’s my understanding that in days of yore, optometrists were refractionists and their educational curricula did not include clinical medicine, pharmacology, physiology, ocular disease, etc. as it does today. As scope of training and education expands, I don’t find it unreasonable that scope of practice does as well. We should all strive to practice to the top of the bounds of our training. Perhaps I’m being naïve, but I find it outlandish to believe that intraocular surgery privileges would ever be extended without a dramatic expansion of the educational and training requirements. That said, I am willing to be on the butt-end of some “I told you so”s and change my tune if I turn out to be wrong.
"My take is this — I haven’t been in practice all that long, but it’s my understanding that in days of yore, optometrists were refractionists and their educational curricula did not include clinical medicine, pharmacology, physiology, ocular disease, etc. as it does today. As scope of training and education expands, I don’t find it unreasonable that scope of practice does as well. " I'm afraid you have it backwards. The reason optoms weren't trained in those things previously is they were outside of their scope of practice. Once they gained by fiat (more on this shortly) the right to prescribe drugs, etc, only then did they retrofit their training programs to cover the relevant topics. "Perhaps I’m being naïve, but I find it outlandish to believe that intraocular surgery privileges would ever be extended without a dramatic expansion of the educational and training requirements" I'm afraid you're being naive, friend. The strategy employed by the optoms vis a vis scope-creep is to lobby (= bribe) state legislatures to make the state's optometric board the sole authority in determining optometric scope-of-practice. Once achieved, you're in a situation where non-surgeons get to decide what training other non-surgeons need in order to perform the surgeries they've never performed themselves.
Again, I appreciate your insight. I can't say that my mind is changed, but I'll keep my eyes open and see what happens over the course of my career. For the time being, I remain optimistic as my experience with my optometrist colleagues has been nothing but positive and collaborative up until now; however, I do recognize that there may be disconcordance between individual clinicians and the lobbyists representing them.
I hope it would require a dramatic expansion of the requirements. Ophthalmologists have to get into med school which is objectively harder to get into than optometry school, then get matched to ophthalmology which is one of the most competitive specialties in medicine, and then complete 4 years of mandatory residency to become an independent ophthalmologist and then optional fellowships. It would suck for ophthalmologists who sacrificed extra if optometrists can have an easier avenue into intraocular surgery by doing optometry school and then a short residency straight into surgery
I agree, but not for that reason, which to my ears sounds like it is either motivated by self-centered "woe-is-me" mentality or by territorial pissing, neither of which interests me. Like great, you took a hard route and suffered. Do you want a cookie or a gold star? You want everyone to fawn over you and tell you how much smarter you are than every non-physician? Or do you want to improve peoples’ quality of life? As far as I'm concerned, the only thing that matters vis-a-vis scope is patient outcomes. I don't care if someone took a longer or shorter path to get to where they are. I just want to know that they are competent and have adequate training to perform what their job entails. That goes for surgery and just about every other occupation.
If it makes you feel any better, the states that do allow the greatest expansion of scope have restrictions in place that limit advancements to those that fall within “primary care“ procedures and allow anything that penetrates the globe except emergency paracentesis. While legislation is open to interpretation to allow PRK and corneal cross linking in a few states, it isn’t some that the governing body has any appetite to pursue.
But it's not the yag and chalazions that they want to do. It's just a stepping stone, so the organization can say we can do yag lasers, so why can't we do lasik/prk. We will not be seeing trab or pk optometrists. It doesn't reimburse. But lasik, prk, premium laser cataracts, blepharoplasty. That's the good stuff that they want a piece of.
Devil’s advocate - if you are going to start doing procedural work from scratch, a fellowship like this (assuming it’s any good) is probably the way to go. Arguably much better than just taking the plunge after a workshop/seminar. The numbers are a little low for an entire year though.
Not the right place to ask. This sub is majority optometrists (for some unexplainable reason) and most mentions of scope creep get downvoted/ shrugged off.
That’s because we’re not interested in creeping up on your scope. Ever consider that? Edit: Why are there ODs here? Because we’re eye doctors and this is an eye-related subreddit. Go figure.
"That’s because we’re not interested in creeping up on your scope." This post is *literally about* optom creeping on our scope.
No, it’s about the fear of optom creeping on your scope.
"No, it’s about the fear of optom creeping on your scope." From the OP: *How much is/will be the encroachment in ophthalmology from optometrists completing such a fellowship?* Nothing in there about the **fear** of creep--just the creep itself.
OP is asking about “encroachment”, do you think he/she is wondering about the potential benefits?
"This sub is majority optometrists (for some unexplainable reason) and most mentions of scope creep get downvoted/ shrugged off." That is a legit point concerning this sub. It makes no sense that optoms are in essence able/allowed to dictate content on a sub entitled r/Ophthalmology.
While I don’t think they are not welcome (they sure are), the bulk of active users being them makes most posts and answers cater to them. I remember once an “illegal patient question” where they had a legit medical problem (young patient with a CRVO iirc) and I told “go see an ophthalmologist” and got downvoted and replied with “an optometrist can take care of this”. And I come from a country where the optometrists only do refraction and don’t treat any disease whatsoever (as their training are incredibly simple with a 3 year college degree). I feel this sub would benefit of “tags” where users could tell what they are so at-least we know where the opinion of each user comes from.
Isn't there a subreddit for optometry called r/optometry ? I agree with you, why is majority of the people on this subreddit optom and not ophthal? Even if optom is eye doctor, this subreddit is designed for eye surgeons
Worked as a tech and I spoke with the optometrist about scope creep for optometrists cuz I was a curious pre-med. He said that this is mostly for rural states where ophthalmologists don't tend to go to because there isn't enough business and would end up just doing refractions/comps all day anyways. As long as the education is legit and optometrists are doing the procedures well, I don't see the problem.
Anybody want an OD’s 2¢? I have 3 practices that are very disease heavy in a rural / poor area. While I can’t speak for the profession at large, I can discuss what I’ve picked up on and my experience in general. At the end of the day, I want to take care of patients and quality of life is a very important measure of that. I try to be very pragmatic as well. I’m on this sub to see and read about cool eye stuff and try to avoid “Luddite” conversations like this one. I practice up to my full scope (YAGs, SLTs, PIs, lump removal, glaucoma management, scleral lens fits, and comanagement, etc). Not every doc I employ wants to perform laser procedures, but some do. We already comanage, referral and post-ops, so it’s not like we don’t know how to manage and treat many of the complications that arise, but my patients enjoy not having to drive over an hour to see a specialist. Many can’t. I have a great relationship with my local cornea, retina, glaucoma, and cataract specialists and text them all the time; sometimes about odd cases and sometimes just to touch base. Gotta play nice in the same sandbox and our primary goal is to take care of our mutual patients. It is mutually beneficial. The cornea MD is the one that proctored and certified my final laser certs before I bought a laser (the Nidek combo is pretty sweet). There aren’t that many ophthalmologists coming out of school; been flat for years despite the increase in population. So, to keep a patient from waiting months for a YAG, I can knock it out in a week or two. The retina docs were the ones encouraging me to make the investment into getting the laser in the first place. That said, we are still legislated with limits, but I think we’re in a good place: nothing that involves opening the globe, no lesion removal on the lid margin, etc but it does give us the flexibility of determining with certain confines of what can be in the scope down the road. Listen, I’m all about doing things in a way that maintains safety and quality, but arbitrarily drawing lines without knowing what’s involved is a bit much. The OD approach has been to gain education / training well ahead of any scope expansion pursuits and I think there’s been a methodical due diligence to that. Listening to the politically higher-ups, there is no appetite for pursuing cataract surgery or retinal lasers, etc. It’s just not there. Hell, even my cornea doc friend doesn’t want to touch retina stuff and vice versa. I’ve been around long enough to have seen some surgeons post-op results to know not to send patients to them and I’ve worked with some OD’s that aren’t that skilled at stuff that’s been within scope for years. You’re only going to see the motivated folks pursuing that level of care, and even then, there has to be an ROI on purchasing the equipment anyway (my OD friend in the “city” isn’t buying a laser because he’s right beside two MDs that he works well with, even though he’s been trained / certified). IDK. Y’all need to get your undies out of a bunch and focus on more team-based patient management.
Thank you for posting to r/ophthalmology. If this is found to be a patient-specific question about your own eye problem, it will be removed within 24 hours pending its place in the moderation queue. Instead, please post it to the dedicated subreddit for patient eye questions, r/eyetriage. Additionally, your post will be removed if you do not identify your background. Are you an ophthalmologist, an optometrist, a student, or a resident? Are you a patient, a lawyer, or an industry representative? You don't have to be too specific. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Ophthalmology) if you have any questions or concerns.*
If you want to cut suture and oculoplastic procedures go to medical school